The “knowledge-practice gap” is a well known problem in health professions education and an enormous amount of time is spent complaining about how difficult it is to narrow the gap. The truth is, the knowledge-practice gap is a problem of our own making, and the name we’ve given this problem hints at the answer.
We’ve set it up so that there is a tension between what happens in the classroom (acquire knowledge) and what is supposed to happen in practice (use knowledge). Or, to be more specific, there is a tension between how students think and behave in the classroom and how we want them to think and behave in the clinical context. This is the “gap” that we’re always talking about bridging; the difference between the knowledge that students acquire in the classroom, and the practical application of that knowledge in clinical practice.
However, instead of treating the problem as something natural to be overcome (“this is just the way it is”), we can just accept that the reason the gap exists is simply because what most of what we expect students to do in the classroom is not a practice at all. We set up a situation where we create different contexts for knowledge acquired and knowledge applied and then complain when students struggle to move between the different contexts.
The truth is that we already have good evidence to suggest alternative ways of thinking about the “different contexts” problem, and we know what to do about it. Situated cognition is a learning theory that proposes that:
“…knowledge is situated, being in part a product of the activity, context, and culture in which it is developed and used.”
In other words, knowledge must be acquired in similar contexts to the ones in which it must be used. If you think about the classroom context, what ways of thinking and being are students required to practice? Are they required to practice at all? In order to satisfy most physiotherapy educators, our students simply need to show up, sit down and listen. Even if we assume that they are able to construct knowledge in some meaningful way from this traditional approach to learning (generally speaking, they are not), how does this practice enable them to apply what they learn in classroom to the clinical context? Simply put, it doesn’t. The reality is that the knowledge-practice gap exists because of the way we teach.
In order to address the problem of the knowledge-practice gap we need to accept that students’ ways of thinking and being in the classroom must be similar to the ways of thinking and being we expect in the clinical context. We must therefore give students learning tasks in the classroom that require them to think and behave in the same way as we expect them to think and behave while on clinical rotation. The classroom practice and the clinical practice must therefore be similar. Seen from this perspective, there would be no knowledge-practice gap because there would be no difference in the contexts in which knowledge is acquired and how it is used.
So, how do we create a classroom context where students are expected to think and behave in ways that are similar to how we expect them to think and behave in the clinical context? I think that Authentic learning is a good place to start. It’s a teaching framework that operationalises situated cognition. In other words, it’s a way of thinking about learning task design that includes attributes that would cause students to think and behave in one context that would help develop those processes for other contexts. I’ve written some notes on Authentic learning before, so won’t go into detail here, other than to share the characteristics of authentic learning, which are that tasks:
- Should have real-world relevance i.e. they match real-world tasks
- Are ill-defined (students must define tasks and sub-tasks in order to complete the activity) i.e. there are multiple interpretations of both the problem and the solution
- Are complex and must be explored over a sustained period of time i.e. days, weeks and months, rather than minutes or hours
- Provide opportunities to examine the task from different perspectives, using a variety of resources i.e. there isn’t a single answer that is the “best” one. Multiple resources requires that students differentiate between relevant / irrelevant information
- Provide opportunities to collaborate should be inherent i.e. are integral to the task
- Provide opportunities to reflect i.e. students must be able to make choices and reflect on those choices
- Must be integrated and applied across different subject areas and lead beyond domain-specific outcomes i.e. they encourage interdisciplinary perspectives and enable diverse roles and expertise
- Seamlessly integrated with assessment i.e. the assessment tasks reflect real-world assessment, rather than separate assessment removed from the task
- Result in a finished product, rather than as preparation for something else
- Allow for competing solutions and diversity of outcome i.e. the outcomes can have multiple solutions that are original, rather than a single “correct” response
Looking at the above list it should be easy to see how tasks designed with these characteristics in mind would be similar to the ways we would think about successful clinical practice. In other words, you could see how students who could successfully solve problems designed with this framework might also be able to solve clinical problems. The tasks we give them in the classroom would require them to think and behave in ways that we expect them to think and behave in clinical practice. No more knowledge-practice gap?